Ation A cardiac rehabilitation exercise program ...

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Short Communication

A cardiac rehabilitation exercise program potentially inhibits progressive inflammation in patients with severe Chagas cardiomyopathy: A pilot singlearm clinical trial

Luiz Fernando Rodrigues Junior1,2, Fernanda de Souza Nogueira Sardinha Mendes1, Vivian Liane Mattos Pinto1, Paula Simplicio da Silva1, Gilberto Marcelo Sperandio da Silva1, Roberta Olmo Pinheiro3, Andr?a Silvestre de Sousa1, Mauro Felippe Felix Mediano1 1Laboratory of Clinical Research on Chagas Disease, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil, 2Care Support Division, Physical Therapy Service, National Institute of Cardiology, Rio de Janeiro, RJ, Brazil, 3Leprosy Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil

Background: Cardiac rehabilitation exerts antiinflammatory effect on several cardiovascular diseases; however, these effects were not described for Chagas cardiomyopathy, which is associated with proinflammatory imbalance. Materials and Methods: Ten patients with severe Chagas cardiomyopathy performed 8 months of exercise training in a cardiac rehabilitation program. Interleukin1 beta (IL1), IL8, IL10, interferon gamma (IF), tumor necrosis factor alpha (TNF), and monocyte chemoattractant protein1 (MCP1) serum levels were measured using enzymelinked immunosorbent assay at baseline, 4, and 8 months. The influence of exercise on cytokine levels was evaluated using the oneway analysis of variance for repeated measurements, with Bonferroni posttest for multiple comparisons. Results: Levels of proinflammatory (TNF, IL1, IL8, IF, and (MCP1) and antiinflammatory (IL10) cytokines did not vary significantly during the observation period. Conclusion: Exercise may benefit patients with severe Chagas cardiomyopathy by curbing the production of proinflammatory cytokines in this disease characterized by a continuous state of inflammation.

Key words: Cardiac rehabilitation, Chagas cardiomyopathy, cytokines, heart failure

How to cite this article: Rodrigues Junior LF, Mendes FSNS, Pinto VL, da Silva PS, Sperandio da Silva GM, Pinheiro RO, et al. A cardiac rehabilitation exercise program potentially inhibits progressive inflammation in patients with severe Chagas cardiomyopathy: A pilot singlearm clinical trial. J Res Med Sci 2020;25:18.

INTRODUCTION

Chagas disease is a lifethreatening illness caused by Trypanosoma cruzi, a protozoan parasite. The symptoms occurring during the chronic phase of this disease are thought to result from dysregulation of the immune system. The progression from the chronic indeterminate form of Chagas disease to chronic chagas cardiomyopathy (CCC) has been associated with the overproduction of several proinflammatory cytokines such as interferon gamma, tumor necrosis

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DOI: 10.4103/jrms.JRMS_175_18

factor alpha (TNF), and interleukin1 beta (IL1), and the underproduction of the antiinflammatory cytokine IL10.[1,2]

Cardiac rehabilitation programs (CRPs) include regular physical exercise, which apparently lowers morbidity and mortality rates in patients with cardiovascular diseases by reducing inflammation.[3] Specifically, exercise decreases the serum levels of proinflammatory cytokines such as TNF, IL6, and monocyte chemoattractant protein1 (MCP1) and increases the serum levels of antiinflammatory proteins such as IL10

This is an open access journal, and articles are distributed under the terms of the Creative Commons AttributionNonCommercialShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work noncommercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

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Address for correspondence: Dr. Mauro Felippe Felix Mediano, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Avenida Brasil 4365, Manguinhos, 21040360 Rio de Janeiro, RJ, Brazil. Email: mauro.mediano@ini.fiocruz.br, mffmediano@ Submitted: 23Jul2019; Revised: 24Oct2019; Accepted: 05Dec2019; Published: 20-Feb-2020

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? 2020 Journal of Research in Medical Sciences | Published by Wolters Kluwer - Medknow

| 2020 |

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Rodrigues Junior, et al.: Exercise and inflammation in Chagas cardiomyopathy

and IL1 receptor antagonist.[4] However, whether it also ameliorates inflammation in patients with severe CCC is unknown. Thus, this study aimed to determine the effects of a CRP on the levels of inflammation markers in patients with severe CCC.

MATERIALS AND METHODS

warmup and a final 5min cooldown), strength exercises for the major muscle groups (20 min), and stretching (10 min). The exercise training intensity was based on the patient's heart rate during cardiopulmonary exercise testing, corresponding to the anaerobic threshold minus 10% in the first month of exercise training and the anaerobic threshold plus 10% in the following months.

In the present pilot study, patients were included from March 2013 to December 2014 at the Evandro Chagas National Institute of Infectious Disease (INI/FIOCRUZ, Rio de Janeiro, Brazil). Details of the pilot study, along with the clinical characteristics of the patients were presented elsewhere.[5] In brief, the selected patients were >18 years of age and were clinically stable during the 3 months before the study. They tested positive for T. cruzi in two serological tests (an enzymelinked immunosorbent assay [ELISA] and indirect immunofluorescence, administered concurrently). Patients with Stages C or D Chagas cardiomyopathy were included if they presented with typical electrocardiographic alterations, left ventricular ejection fraction (LVEF) ................
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